Epidemiology Research Lab

The government response to the Senate Select Committee report is out. Will the changes reduce stillbirth incidence?

As lead of the WA Perinatal Epidemiology Group, Prof Gavin Pereira served as an Expert Witness in the Australian Federal Senate Select Committee enquiry into stillbirth research and education. The contributions to the enquiry were published in Commonwealth of Australia Hansard and two members of the team, GP and RS , are acknowledged in the committee’s final report. The government have now published their response to the report. Overall the government response is positive. Among the adopted recommedations is the creation of nationally standardised data on stillbirth. These data will make a great contribution to discovering causes of stillbirth iff (ie. if and only if) these data are accessible at an individual level and made available at low cost to researchers. One fundamentally important point missed by the government response is that the cutpoint of gestational age used to define a stillbirth (20 weeks in Australia) is completely arbitrary. From this point a miscarriage is perceived as viable and becomes defined as a stillbirth. What is the difference between a late miscarriage and an early stillbirth? Very little. The aetiology of fetal death changes smoothly across the continuum of gestational age. Lack of acknowledgement of miscarriage can lead to false inference. If there are shared causes of miscarriage and stillbirth and we limit our research to pregnancies that make it to 20 weeks, we inherently introduce bias because all of these pregnancies, including the stillbirths, are healthy enough to have survived to 20 weeks. We need to consider miscarriage at the same level of importance as we consider stillbirth.

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